Insurance Adjuster Loses Workers’ Compensation Stress Claim

Think your job as an insurance adjuster is stressful? So did the claimant in Day v. Travelers (COA19-704, Aug. 4, 2020, unpublished), when she filed an occupational disease claim for anxiety and depression. However, like many claimants before her, Ms. Day learned the hard way that work creates stress for everyone, not just for insurance adjusters.

In North Carolina, “stress claims” usually are analyzed as occupational disease claims, wherein the claimant must prove that the disease is characteristic of persons engaged in the particular trade or occupation in which claimant is engaged, rather than an ordinary disease of life to which the public generally is equally exposed. Also, there must be a causal connection between the disease and the job. Generally, those two elements are satisfied when the claimant proves the employment “exposed the worker to a greater risk of contracting the disease than the general public.”

Stress claims are as varied as other workers’ compensation claims; the outcome depends heavily on the facts and circumstances of each accident, job, and medical condition. In Day v. Travelers, the Senior Claims Representative alleged she was assigned to handle 175 to 180 cases at a time, forcing her to work overtime. She also claimed she endured snarky comments from coworkers and supervisors and even was encouraged to handle cases fraudulently by denying compensable cases or lying to insureds. She allegedly developed depression and anxiety with symptoms including tingling in the limbs, loss of voice, trembling, and headaches.

Both the Deputy Commissioner and the Full Commission found the claim not compensable. They agreed with claimant that she sustained stressors at work that caused her anxiety and depression, but they held that the stressors were ordinary diseases of life not peculiar to the work of an insurance claims adjuster. Notably, the Commission found that claimant’s employment did not place her at an increased risk of contracting anxiety and depression as opposed to the general public. As for the claims regarding Travelers’ alleged immoral practices and fraud, the Commission found that claimant’s testimony lacked credibility, based on credible testimony to the contrary by other Travelers employees with similar job duties.

Claimant’s appeal was based on a number of theories, primarily the fact that the Commission’s findings of fact omitted mentioning some portions of expert testimony and some authorities and facts considered by the experts. The Court of Appeals dismissed claimant’s arguments and held, consistent with a long line of cases, that the Commission must consider all the evidence but need not include every single detail in its final Opinion and Award. Occupational disease claims can be difficult to prosecute and even more difficult to defend. But as this case suggests, both the Industrial Commission and the Court of Appeals may be getting fed up with claims that a diagnosis of anxiety and depression gives rise to a compensable claim. If you have questions about defending a stress claim in North Carolina, contact the workers’ compensation team at Anders Newton.

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